Prophylactic Injection of Hypertonic Saline-epinephrine Oral to the Papilla for Prevention of Postsphincterotomy Bleeding

Abstract

Endoscopic injection of hypertonic saline-epinephrine (HSE) solution oral to the papilla effectively arrests uncontrolled bleeding after endoscopic sphincterotomy (ES). The aim of this study was to evaluate the efficacy of a prophylactic injection of HSE solution oral to the papilla before ES for prevention of post-ES bleeding. Patients scheduled for ES were recruited into this study. Before ES, patients randomly underwent a single submucosal injection of HSE solution (1 mL) 1 to 2-cm oral to the papilla (injection group) or no injection (noninjection group). After ES, patients were prospectively evaluated for occurrence of post-ES complications such as bleeding, perforation, and pancreatitis between the groups. A total of 120 patients were randomized to the injection group (n=60) or the noninjection group (n=60). The 2 groups were similar with respect to all background variables. Bleeding occurred in 10 patients (8.3%), and the incidence of bleeding was significantly higher in the noninjection group (9/60) than in the injection group (1/60) (P=0.017). Retroperitoneal perforation occurred in 1 patient (injection group) (0.83%). Pancreatitis occurred in 10 patients (8.3%), and the incidence of pancreatitis tended to be higher in the noninjection group (8/60) than in the injection group (2/60) (P=0.095). Prophylactic injection of HSE solution oral to the papilla before ES is a simple and inexpensive method, and is effective for prevention of post-ES bleeding.